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About 13 percent of U.S. children and 26 percent of those with disabilities or chronic illness see a specialist in a year

About 13 percent of U.S. children saw a specialist during 1999. The percent of visits to a specialist were twice as high for children with a chronic condition or disability (26 percent). Also, the likelihood of uninsured children seeing a specialist was 59 percent lower relative to the corresponding percent for privately insured children. However, among children who had coverage (private, Medicaid, or other), rates of specialist use were similar. Sociodemographic differences in specialist use were pronounced and followed patterns typically found for use of health services, according to a study that was funded in part by the Agency for Healthcare Research and Quality (HS13757).

The researchers found, for example, that use of specialist care was 41 percent lower among blacks, 54 percent lower among Hispanics, and 39 percent lower among other ethnic groups compared with whites. Use of specialty care was 45 percent lower among children in families between 100 and 200 percent of the Federal poverty level and in families that had lower parental education levels (35 percent lower for high school graduates and 66 percent lower with no high school diploma). Surprisingly, children with Medicaid did not have significantly different rates of specialist use compared with children who had private insurance.

Children who had a chronic condition or disability were three times as likely as other children to see a specialist during the year. Karen Kuhlthau, Ph.D., of Harvard Medical School, and her colleagues found no difference in rates of specialist care between rural and urban children, by family status (dual or single-parent family), or by the child's sex. They also found no difference in specialty use for children with Medicaid who did or did not need administrative approval to see a specialist, regardless of the child's condition, disability status, or race/ethnicity. These findings are based on an analysis of data from the 1999 National Health Interview Survey, a nationally representative household survey of health status, insurance, health care use, and demographics.

See "Correlates of use of specialty care," by Dr. Kuhlthau, Rebecca M. Nyman, M.P.H., Timothy G. Ferris, M.D., and others, in the March 2004 Pediatrics 113(3), pp. e249-255.

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